ACCMA Bulletin Sept/Oct 2022

The Alameda-Contra Costa Medical Association …. requests the pleasure of your company

Friday, November 4, 2022 | Reception begins at 6:00 pm The Claremont Club & Spa 41 Tunnel Road, Berkeley, CA

Join us

for the 154th ACCMA Annual Meeting this November. Enjoy a lively reception, formal dinner, and presentation featuring our 2023 ACCMA President, Edmon Soliman, MD, and a very special guest speaker.

GUEST SPEAKER

KEENA TURNER

LEGENDARY #58 AND 4-TIME SUPER BOWL CHAMPION FOR THE SAN FRANCISCO 49ERS

Keena Turner will join us to discuss sportsmanship, teamwork, the championship mindset, and what it took to win and sustain dominance during his eleven-year professional football career. Now, Vice President and Senior Advisor to the General Manager, Keena will highlight his “Team of the Decade", the future of today's Niners, and successful leadership tools and qualities.

COVID-19 SAFETY

Your safety is important to us. We will ensure all county guidelines are being met at the time of the event.

Please visit accma.org/events to register online. Contact us at accma@accma.org or call (510) 654-5383 with any questions.

ACCMA EXECUTIVE COMMITTEE Robert Edelman, MD, President Edmon Soliman, MD, President Elect Albert Brooks, MD, SecretaryTreasurer Suparna Dutta, MD, Immediate Past President COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD James Hanson, MD Terry Hill, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Irene Lo, MD Kristin Lum, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Jonathan Savell, MD Judith Stanton, MD Sonia Sutherland, MD Clifford Wong, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, CMA Trustee Katrina Peters, MD, CMA Trustee MEMBERSHIP & COMMUNICATIONS COMMITTEE Mark Kogan, MD, Chair Patricia Austin, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Michael McGlynn, MD Lamont Paxton, MD Katrina Peters, MD Bindoo Rellan, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

Serving East Bay physicians since 1860

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News & Comments

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PRESIDENT’S PAGE An Honor to Serve

By Robert Edelman, MD, ACCMA President

YOUR ADVOCACY 9

HOD 2022 Major Issue – Physician Workforce

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November General Election Preview

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Public Service Loan Forgiveness

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ACCMA Climate Change Policy

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September/October 2022 | Vol. LXXVIII, No. 4

IN YOUR PRACTICE 11

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Bay Area Physician Wellness Collaborative

California’s Big Move on Data Exchange By the California Medical Association

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COVID Therapeutics Updates

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Abortion Laws and How Physicians Can Protect Themselves By the Medical Insurance Exchange of California

ACCMA PROGRAMS 15

ACCMA Annual Meeting

Addressing Food Insecurity with Recipe4Health

By Scott Coffin, CEO, Alameda Alliance for Health

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New Members

26

Classifieds

Physician Leadership Program

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

REDUCE – REUSE – RECYCLE Printed in the U.S.A. with soy inks on paper stock certified by the Forest Stewardship Council.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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NEWS & COMMENTS

ACCMA ENDORSES PROP. 1 TO PROTECT ABORTION, CONTRACEPTION RIGHTS

ACCMA has joined CMA and several other health advocacy organizations in supporting Proposition 1, a ballot measure seeking to enshrine an individual’s right to have an abortion, or to use or refuse contraception, in the California Constitution.

ACCMA believes medical decisions—including those around abortion or contraception—should be decided by patients in consultation with their health care provider. To learn how to support this initiative or to view a fact sheet directly from the Yes on 1 campaign, visit protectabortionca.com.

APPLY FOR PHYSICIAN LOAN REPAYMENT PROGRAMS

Steven M. Thompson Physician Corps Loan Repayment Program and the Licensed Mental Health Services Provider Education Program are accepting applications until 3 pm on October 31, 2022. Check your eligibility or find more information on loan repayment programs by visiting bit.ly/3cA2Jj5.

MEDI-CAL RX UPDATES

Effective September 16, Medi-Cal Rx prescribers will be required to submit prior authorizations for new start medications in 11 drug classes. DUR Reject Code 88 edits have been turned on as of July 22. Activation of Reject Code 80 has been postponed due to provider feedback. Revised provider alerts and other informing materials are continuously posted to bit. ly/3CDDBma.

PRIOR AUTHORIZATION REFORM

Senator Richard Pan, M.D. introduced SB 250 to reduce administrative burdens in physician practices so physicians can spend more time dedicated to patient care. ACCMA and CMA support SB 250 which will reform the prior authorization process in a comprehensive way. The result will be less clinical time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision making. SB 250 will be heard soon in the Assembly Appropriations Committee.

CALIFORNIA’S BIG MOVE ON DATA EXCHANGE

The Data Exchange Framework, abbreviated “DxF”, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. Once all actors have signed the Single Data Sharing Agreement, practices and others will be contractually obligated to share data across the health care system.

The date by which practices must comply with this requirement depends on the size of the practice. Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. Please find the full article from CMA on page 11.

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UPDATE PRACTICE DEMOGRAPHIC INFO

Under SB 137, health plans/insurers must verify the accuracy of their contracting providers’ demographic information every 90 days, as opposed to the 180-day or annual requirement prior to January 2022. Providers who fail to comply with the verification requests risk payment delays and removal from the provider directory. Health plans or insurers may also terminate a contract with a provider for a pattern or repeated failure to update the required information. Practices should also note that if the practice is: moving, adding or losing providers, changing the practice name/TIN, closing a practice or changing specialties, you should inform payors with at least 90 days advance notice to prevent payment issues.

ACES AWARE REPORT

The ACEs Aware initiative released a new quarterly data report detailing the number of Adverse Childhood Experience (ACE) screenings conducted for children and adults in California between January 1, 2020 and September 30, 2021. The data show that Medi-Cal clinicians – primarily pediatric, family medicine, and behavioral health professionals – conducted about 987,500 ACE screenings of more than 793,000 unique Medi-Cal beneficiaries. The report also shows that between December 4, 2019 and May 31, 2022, more than 23,400 individuals have taken the ACEs Aware training, 11,900 of whom are Medi-Cal clinicians who are ACEs Aware-certified and eligible to receive Medi-Cal payment for conducting ACE screenings. Read more at bit.ly/3AWdu8L.

LEGISLATURE PASSES AB 1636 TO PROTECT PATIENTS

California Legislature unanimously passed CMA-sponsored bill AB 1636 that will ensure physicians who have committed sexual misconduct are prohibited from the ability to petition the medical board for reinstatement. In December 2021, the LA Times reported that the Medical Board of California reinstated 10 of 17 California physicians who previously had their licenses revoked for sexual misconduct. AB 1636 will protect patients and the integrity of the medical profession by ensuring that physicians who commit sexual misconduct are appropriately disciplined. The bill now sits on the governor’s desk awaiting signature. Read more at bit.ly/3AXNtWw.

FUNDING FOR PROVIDERS SERVING PEDIATRIC POPULATIONS

KidsVaxGrant 2.0 will help medical practices with 200 physicians or fewer serving pediatric populations administer COVID vaccines to their infant and toddler pediatric patients.

Administered by Physicians for a Healthy California (PHC), CDPH is investing approximately $10 million to fund the KidsVaxGrant 2.0. Individual practices may be eligible for up to two grant opportunities – awards between $10K-25K. Providers serving pediatric populations that were previously awarded a KidsVaxGrant are eligible to apply for KidsVaxGrant 2.0.

The application deadline is October 14. Visit phcdocs.org/ Programs/CalVaxGrant.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEWS & COMMENTS

HELP PROMOTE SCHOOL VACCINATIONS

Visit the www.ShotsforSchool.org CDPH page for information on immunization laws and required vaccinations for students in California. Families that are having difficulty obtaining required immunizations prior to the start of school can contact their local health department for help in finding a place to get needed immunizations. Additional resources are available in the ‘Don’t Wait – Vaccinate’ toolkit (bit.ly/3TrTPVm) to educate Californians about the importance of staying up-to-date on vaccinations and routine screenings.

UNITEDHEALTHCARE COMMERCIAL FEE SCHEDULE UPDATE

UHC issued a notice of amendment to 3,500 physicians tied to the UHC 2008 commercial fee schedule advising providers of the transition to a new fee schedule effective October 15.

Please be aware that fee schedules will transition automatically and no action is required on your part. If you have any questions or would like to confirm if your practice will be affected, please contact UHC’s Network Account Manager at west_physician_contracting@uhc.com.

COVID-19 VACCINE COSTS SHIFTS TO INSURERS, PATIENTS

HHS will be meeting with drugmakers, pharmacies, and other stakeholders on August 30 to map out how insurance coverage and reimbursements would cover the costs of COVID-19 vaccines, tests, and treatments. As COVID-19 cases drop, the Biden Administration shifts this burden onto insurance and patients. Additional news indicates that HHS is likely to extend the PHE into January 2023, ensuring expanded Medicaid coverage, telehealth services, and boosted payments to hospitals.

CA BUDGET SUPPORTS UNIVERSAL HEALTH CARE

Governor Gavin Newsom signed the 2022-23 state budget, which continues California’s commitment to achieving universal health care access. The $308-billion budget addresses many of CMA’s key priorities, including a phased-in system to provide full scope Medi-Cal coverage to all income eligible Californians regardless of age or documentation status by January 1, 2024.

Visit bit.ly/3CFlFYb for a list of some of the key health care provisions included in the final budget.

COVID-19 TREATMENT AND PREVENTION GUIDELINES

The National Institute of Health regularly updates their ‘What’s New in the Guidelines’ webpage at bit.ly/3cuOZpF with upto-date information regarding COVID-19 treatment. Alameda County Public Health published a health advisory available at bit.ly/3AZFmZN. Some of the most recent revisions include: consider repeat dosing with Evusheld every six months if patients need ongoing protection, Remdesivir fully approved for treatment of adults and children for in- and out-patients, and limited prescribing of Paxlovid by pharmacists now allowed under EUA. Read the full article on page 13.

MEDIA TRAINING FOR PHYSICIANS

Are you interested in adding your voice in support of Prop.

1 to protect abortion rights in California and/or Prop. 31 to stop the sale of flavored tobacco products? The campaigns in support of the measures are looking for physician volunteers to serve as spokespeople and will be conducting a series of trainings in the coming weeks all over the state (and remotely) where physician volunteers will get message training for media interviews, author op-eds and participate in press conferences and other media events. To sign up, please email svelayas@ cmadocs.org and include your name, title, phone number, email address, and which proposition/training you would like to participate in.

UPCOMING EVENTS

ACCMA 154TH ANNUAL MEETING

Friday, November 4 | 6:00 to 8:00 pm Claremont Club & Spa, Berkeley, CA The Annual Meeting is a fun and entertaining evening for the East Bay health care community to connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program.

This year’s guest speaker is Keena Turner, fourtime Super Bowl champion for the San Francisco 49ers. Read more on page 15. Go to accma.org/ events to purchase tickets online.

BAY AREA PHYSICIAN WELLNESS COLLABORATIVE

Tuesday, November 15 | 6:00 to 8:00 pm Free | CME Available | Online More than 60 Bay Area leaders from physician organizations are convening bimonthly on Zoom to share their experiences on how they are improving physician wellness in their workplaces and to learn from one another in a collaborative roundtable discussion. The November 15 discussion will focus on building a center for physician wellbeing within your organization with self-care support systems, peer support resources, mental health referrals and consultation services, life-needs support mechanisms, and other comprehensive wellbeing resources. Read more on pages 16 and 17.

To request an invitation to enroll, visit bit. ly/3PcTd3L. TO VIEW A FULL LIST OF UPCOMING EVENTS AND TO REGISTER ONLINE, VISIT PATHLMS.COM/MEDICAL-SOCIETY!

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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PRESIDENT'S PAGE

An Honor to Serve

By Robert Edelman, MD, ACCMA President

I

t has been a tremendous honor to serve as your ACCMA President. Over the past year, we have confronted several challenging issues that have required the ACCMA and CMA to once again step up and fight for the prerogatives of our profession and the well-being of our patients.

Our top priority at the start of 2022 was defeating a major anti-MICRA initiative that had qualified for the November 2022 ballot. Misleadingly titled the Fairness for Injured Patients Act (FIPA), this costly and dangerous initiative would have quintupled MICRA’s cap on noneconomic damages, and would have eviscerated MICRA by excluding an estimated 90% of malpractice suits from MICRA protections. We were prepared for an allout, all-hands-on-deck effort to defeat it.

Fortunately, in May, the CMA reached a negotiated agreement in the form of AB 35 – the MICRA Modernization Act – to keep MICRA intact. MICRA’s $250,000 cap on noneconomic damages, which had remained unchanged since 1975, realistically could not be kept at that level forever, and was MICRA’s primary vulnerability. Under AB 35, the cap on noneconomic damages will increase from $250,000 to $350,000 for non-death cases and $500,000 for wrongful death cases on January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases. After 10 years, a 2.0% annual inflationary adjustment will apply. This avoided the complete lifting of caps on noneconomic damages. To our benefit, the new law also makes adjustments to periodic payments, keeps limits on attorney contingency fees, and establishes a new statute that ensures protections for benevolent gestures and statements of fault by health care providers. It also preserves many important guardrails of MICRA, including the one-year statute of limitations to file a case, the option of binding arbitration, and allowing other sources of compensation to be considered in award determinations.

We also focused on a number of other legislative priorities.

We held numerous district meetings with our local elected officials, and dozens of members participated in CMA’s 48th Annual Legislative Day in Sacramento. Among the bills we lobbied for was SB 250, a bill introduced by Senator Richard Pan, MD, that would relieve physicians from obtaining prior authorization if at least

90% of their prior authorization requests were approved in the prior year. The bill cleared the Senate and was passed out of the Assembly Health Committee, but it unfortunately did not make it through the Assembly before the August deadline. Prior authorization reform remains a major priority at the state and federal level and efforts will continue next year.

Another area of focus was physician workforce. ACCMA and CMA lobbied both HHS and our members of Congress to ensure that California physicians were not excluded from federal loan repayment programs due to a loophole that bars physicians who are not directly employed by a hospital system, which is not allowed under California law. CMA also sponsored AB 2132 (Villapudua) to establish a pilot program to provide underrepresented students with financial aid from undergraduate through residency in exchange for working in medically underserved areas.

The bill unfortunately did not get much traction this year but will continue to be a focus in the future.

ACCMA and CMA also continued our advocacy efforts around Medicare payment reform and stopping Medicare payment cuts. In a 2022 CMA survey, 72% of California physicians said Medicare FFS payments do not cover their costs of providing care; compounding this, physicians are facing potential payment cuts of more than 8.5% in 2023. To address these looming cuts, ACCMA leaders met with our Congressional representatives in August and urged them to end this annual ritual of payment cuts and replace it with a more comprehensive strategy to reform Medicare physician reimbursement for the long term and ensure patient access to Medicare services. You can read more about the meetings between ACCMA physicians and our local Congressmembers on page 10 in this issue.

Of course, we cannot look back on this year without thinking about the millions of patients and physicians affected by the Supreme Court’s decision to overturn Roe v. Wade and Planned Parenthood v. Casey. This ruling has already had detrimental effects on access to reproductive health care services and on the physician-patient relationship. ACCMA is proudly supporting Proposition 1 to enshrine in the California Constitution an continued on page 24 ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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NEWS & COMMENTS

(continued from page 21)

UNDERSTANDING WORK RVUs CALCULATION & COMPENSATION

Work RVUs aim to measure and compensate for a physician’s productivity but fail to account for insurance payor reimbursement rates or collections revenue. Still, WRVUs are increasingly becoming the compensation method of choice for hospital foundations, universities, and medical groups. It is crucial that physicians learn how to calculate WRVUS if joining an organization or being acquired, as well as understand the compensation methodologies, how to negotiate dollars per WRVU, and how to monitor the recordation of WRVUs for accurate compensation.

AVAILABLE ON DEMAND bit.ly/3puf7nt

This series consists of three 20-25 minute segments: SESSION 1

SESSION 2

SESSION 3

CALCULATING RVUS: MEASURING PRODUCTIVITY

NEGOTIATING RVUS: COMPENSATION AND BONUSES

MONITORING RVUS: FORMULAS AND CONTRACTS

SPEAKER: DEBRA PHAIRAS Debra Phairas, President Practice & Liability Consultants, LLC, has assisted physicians/groups to calculate WRVUs and hospitals with compensation formulas, and has been an expert witness in cases involving compensation and WRVUs. www.practiceconsultants.net Please contact ACCMA Associate Director of Education and Events, Jennifer Mullins, at jmullins@accma.org with any questions.

MONKEYPOX

DIAGNOSIS, TREATMENT, & PREVENTION A v a i l a b l e On De ma n d a t b i t . l y / 3 Co Go 2 u

ACCMA has partnered with representatives from Alameda County and Contra Costa County Public Health to offer a 1-hour presentation covering: Clinical manifestations of monkeypox Viral transmission Signs and symptoms Vaccinations and treatment Public health measures underway

CME Available

PRESENTERS Nicholas Moss, MD, MPH Alameda County Division of Communicable Disease Control and Prevention Ori Tzvieli, MD Contra Costa Health Services

Accreditation Statement: ACCMA is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education.

Credit Designation Statement: ACCMA designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

HOD MAJOR ISSUE

HOD Major Issue – Physician Workforce

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he 2022 CMA House of Delegates meeting, to be held in Los Angeles from October 22 to 23, will discuss three major issues, two that are actionable (Physician Workforce and Health Care Reform) and one for information (Mental Health).

The Physician Workforce Major Issue would review current CMA policy that is related to workforce and identify if it sufficiently addresses the needs to protect existing physician workforce and grow it in a way that supports increased access to care by a workforce that reflects California’s diverse population.

Currently California is experiencing a health care provider shortage and it has reached crisis mode. In California, only two regions (the greater Bay Area and the Sacramento area) have enough primary care doctors: between 60 and 80 doctors per 100,000 people. Most regions fall below the 60-doctor benchmark that experts consider adequate, and California’s rural regions fared much worse. In 2030, demand for primary care clinicians in California is projected to exceed supply by 12 to 17%.

A 2021 survey done by the California Health Care Foundation of physicians, nurses, nurse practitioners, physicians assistants, and behavioral health specialists in California found that 59% felt burned out, 57% felt overworked, and 50% felt frustrated. A more recent survey by the American Medical Association found that about 20% of physicians said they were likely to leave their current practice within two years, while one-third planned to reduce their work hours within the next 12 months.

Further, California’s physician workforce does not reflect the demographics of California’s population. Black and Latinx physicians are under-represented relative to their shares of California’s population. In terms of language access, Spanish-speaking physicians are the most under-represented in the physician workforce in California with only 62.1 per 100,000 Spanish speakers. Compare that disparity to the 344.2 physicians who only speak English per 100,000 population that only speaks English. While medical students and residents had more racial and ethnic diversity than practicing physicians, only 4.7% of medical school graduates and 5.1% of residents and fellows were Black, and 7.2% of medical school graduates and 6.1% of residents and fellows were Latinx.

CMA has secured funding for GME through Proposition 56, the tobacco tax passed in 2016, and helped secure additional new funds for GME slots by aligning the tax on e-cigarettes and vaping products to other tobacco products. Yet, despite increased residency slots, there is likely to be an ongoing shortage in primary care and psychiatry for a decade.

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Some of the policy questions for HOD discussion are: Does CMA policy adequately address strategies to protect the existing physician workforce?

Are there additional ways California might address systemic barriers in the medical education and licensure pathways that created the racial/ethnic disconcordance between California’s population and the medical profession?

Are there options that relieve pressure on the system in a way that ensures equitable levels of care and training and creates space to build strategies that require a longer runway?

The full Major Issue report is available at cmadocs.org/hod. If you have any questions or want more information, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org or (510) 654-5383, ext. 6320.

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ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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NOVEMBER ELECTIONS

November General Election Preview

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he 2022 General Election is scheduled for November 8.

Below you will find information regarding key races, state propositions, and ACCMA advocacy on federal legislation.

KEY RACES Senate District (SD) 10 encompasses cities in both Alameda and Santa Clara counties. Lily Mei and Aisha Wahab are the two candidates who will appear on the ballot. The California Medical Association Political Action Committee (CALPAC) has endorsed Lily Mei. Assembly District (AD) 20 encompasses the following cities: Ashland, Castro Valley, Cherryland, Fairview, Fremont, Hayward, Pleasanton, San Lorenzo, Sunol, and Union City. Liz Ortega and Shawn Kumagai are the two candidates who will appear on the ballot. CALPAC has endorsed Shawn Kumagai.

Alameda County BOS District 3 encompasses the following cities: Alameda and San Leandro; a portion of the city of Oakland, including the Chinatown, San Antonio, Fruitvale and Melrose areas; the unincorporated communities of San Lorenzo and Hayward Acres; and a portion of the unincorporated community of Ashland. Rebecca Kaplan and Lena Tam are the two candidates who will appear on the ballot. The Alameda-Contra Costa Physicians Committee (ACCPAC) has endorsed both Rebecca Kaplan and Lena Tam. Contra Costa County BOS District 4 encompasses the following cities: Walnut Creek, Concord, Pleasant Hill, San Miguel, and Clayton. Ken Carlson and Debora Allen are the two candidates who will appear on the ballot. ACCPAC has endorsed Debora Allen.

KEY STATE PROPOSITIONS Proposition 1: Constitutional Right to Reproductive Freedom. This measure would amend the California Constitution to prohibit the state from denying or interfering with an individual’s reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their fundamental right to choose or refuse contraceptives.

Proposition 29: Requires On-Site Licensed Medical Professional at Kidney Dialysis Clinics and Establishes Other State Requirements.

SEIU-UHW is back a third time with another dialysis proposition.

The new proposition is nearly identical to Proposition 23, which 63% of voters overwhelmingly rejected in 2020. This initiative would arbitrarily require a physician, nurse practitioner or physician assistant to be always onsite at dialysis clinics. This measure 10

would move doctors and other providers away from patient care into administrative roles. Please note that ACCMA opposed the two prior initiatives and has also opposed this initiative. This latest proposition will again jeopardize access to care, worsen our health care provider shortage, and increase health care costs for all Californians.

Proposition 31: Referendum on 2020 Law that Would Prohibit the Retail Sale of Certain Flavored Tobacco Products. Opponents of Proposition 31 seek to overturn Senate Bill 793 (SB 793), which was signed into law on August 28, 2020. SB 793 was designed to ban the sale of flavored tobacco products and tobacco product flavor enhancers, with exceptions for hookah tobacco, loose leaf tobacco, and premium cigars. Retailers would be fined $250 for each sale violating the law. The California Coalition for Fairness is campaigning for the veto referendum to repeal SB 793. Through December 31, 2021, the campaign had received $21.16 million, including $10.33 million from R.J. Reynolds Tobacco Co. and $9.83 million from Philip Morris USA. ACCMA LEGISLATIVE MEETINGS Over the course of the 2022 Congress legislative recess, ACCMA members met with Congressmembers to discuss Medicare payment reform, prior authorization, and the Inflation Reduction Act. We want to thank Congressmembers Eric Swalwell, Mark DeSaulnier, Mike Thompson, and Jerry McNerney for meeting with our members to discuss these priorities.

Medicare Payment Reform. We urge Congress to enact Medicare payment reform to provide stability for physicians and patients. In 2023, physicians are facing more than 8.5% payment cuts. Medicare physician payments already lag nearly 40% behind inflation and the costs to operate a medical practice. Since 2001, Medicare hospital and nursing home payments increased 60%, inflation increased by 40%, yet physician payments increased only 7%. In many California communities, there are no primary care physicians accepting new Medicare patients. California patients are facing access to care challenges and California is projected to have the largest physician shortages in the nation over the next decade. Congress must reverse this trend to help patients get the care they need.

Prior Authorization. We continue to fight for medical decisions to be made by trained medical professionals, instead of lay entities more concerned with the corporate bottom line than the quality of patient care. This is why we are supporting HR 3173, S 3018, and HR 7995 to streamline prior authorization continued on page 21

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

DATA EXCHANGE FRAMEWORK

California’s Big Move on Data Exchange By the California Medical Association

With a combination of mandates, a new governing board, and publicly funded assistance, the California Data Exchange Framework (DxF) is set to pull health information exchange into the 21st Century.

Probably every physician practice has had the frustrating experience of trying to deliver the best possible care to a patient, only to be hampered by the inability to access relevant health information. Important pieces of a patient’s history, such as prescriptions, chronic conditions, or previous diagnoses may be trapped in data silos held in a million different places, inaccessible to the patient or the physician at the point of care. Myriad studies of the health care system have shown that lack of health information at the point of care often leads to duplication, waste, and delay.

Despite the widespread adoption of electronic health records (EHRs) across the state, this problem persists. A combination of technology challenges, competitive forces, and some legal uncertainty has kept data locked away from both patients and physicians. Starting in 2020, the federal government began working to address this problem through the 21st Century Cures Act Final Rule, often known as the “Information Blocking Rule.” This rule clarified in federal regulation that patients have the right to access their own medical information through the technology of their choosing. For the first time, physicians, hospitals, and health plans must make that information available. This rule started the country down the path of widespread and seamless data exchange.

Now, the California Medical Association (CMA), is working with the State of California to build on the federal regulations to accelerate and expand data exchange efforts here in the state. After a year of legislative negotiations, State Budget appropriations, and stakeholder meetings, the California Health and Human Services Agency (CHHS) published the Data Exchange Framework on July 5.

The Data Exchange Framework, or DxF, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. It will do this by requiring all those actors to sign the Single Data Sharing Agreement (described below). Once they have signed the agreement, practices and others will be contractually obligated to share data across the health care system.

Importantly, the Data Exchange Framework does not require practices to utilize any particular data-sharing technology. The

state is not building a “Statewide HIE.” When the law that created the framework was being written, CMA’s position was that physicians should have the flexibility to choose the technology that works best for their practice. Based on CMA’s advocacy, the law prohibits the state from forcing physicians into one system.

Instead, the Framework is intended to be “technology agnostic,” meaning that practices are free to choose the method of data exchange that works best for them. This could include a local health information organization, a national data sharing network, or other data sharing technology.

Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. To help practices prepare, this article will give a high-level overview of the Framework, describe some things practices can do to prepare, and point them to some helpful resources CMA is developing.

THE DATA EXCHANGE FRAMEWORK The Data Exchange Framework consists of four major components: 1 Data Sharing Requirement: As described above, the Framework includes a legal requirement that physician practices and other health care entities make data available to other signatories of the Data Sharing Agreement. The date by which practices must comply with this requirement depends on the size of the practice. In general, practices of more than 25 physicians will need to be engaged in data exchange by January 31, 2024. Practices smaller than 25 physicians will have 2 additional years, until January 31, 2026.

2 Single Data Sharing Agreement: To govern the Framework, the state has created the Single Data Sharing Agreement (DSA).

This document is a contract that all practices are required by law to execute by January 31, 2023. The intent of the DSA is to act as a contract between physician practices, hospitals, health plans, etc., that they will make data available to each other upon request. The DSA lays out the parameters of how that data exchange should happen, predominantly via accompanying Policies and Procedures that describe what data elements need to be exchanged, privacy and security standards, and permitted uses of health data. The DSA also continued on page 18 ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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PUBLIC SERVICE LOAN FORGIVENESS

Public Service Loan Forgiveness

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CCMA and CMA have been advocating to fix the federal public service loan forgiveness (PSLF) program to allow California and Texas physicians working in private non-profit hospitals/clinics to receive loan forgiveness. The US Department of Education required all physicians to be directly employed by non-profit hospitals/clinics in order to obtain loan forgiveness. In

California and Texas, state law allows public non-profit hospitals to employ physicians but prohibits private non-profit hospitals from employing physicians. As a result, many California and Texas physicians have been excluded from the program. Below please find a letter that ACCMA sent to the Education Secretary Miguel Cardona.

August 8, 2022 Dear Secretary Cardona, I am writing on behalf of the Alameda-Contra Costa Medical Association – representing 5,000 physician members – to urge the U.S. Department of Education to provide student loan forgiveness under the federal Public Service Loan Forgiveness (PSLF) program to California and Texas physicians who meet all requirements of the PSLF program and who would otherwise qualify for PSLF except that they are not directly employed by private non-profit hospitals due to state laws, which are critically important and protect against corporate, non-physician entities employing physicians and making medical decisions. This corporate bar on the practice of medicine is a critically important law that protects and preserves the independence of physicians’ professional judgment in the care of their patients and ensures that external forces cannot interfere with the physician-patient relationship.

Qualified California and Texas physicians should have equal access to this national loan forgiveness program like our colleagues in all other 48 states. We can meet all the PSLF standards, except we are not able to be employed by private non-profit institutions under our state laws.

While state laws in California and Texas do allow public non-profit hospitals and clinics to directly employ physicians, private non-profit institutions – including community hospitals, children’s hospitals, rural hospitals and district hospitals – are prohibited from directly employing physicians. Therefore, since the inception of the PSLF program, California and Texas physicians who are otherwise qualified to receive loan forgiveness have been inadvertently excluded from a national program in which our similarly situated physician colleagues in all other states can participate.

We support the proposal submitted by the California Medical Association, the California Hospital Association, the Texas Medical Association and the Texas Hospital Association that requires an additional written certification from an authorized official of the public service organization (hospital, clinic) certifying that the physician works full time (30 hours/week) in the private non-profit facility, is authorized through the clinical privileges credentialling process, but is not able to be employed by the facility because of state law. This is an additional standard for California and Texas physicians who are prohibited from being directly hired and paid by the facility. continued on page 26

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID THERAPEUTICS

COVID Therapeutics Updates

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he Alameda County Public Health Department and Contra Costa County Health Services continue to provide information to assist you in identifying and providing COVID-19 treatment and pre-exposure prophylaxis to your eligible high-risk patients. Effective treatment is available and should be offered to all high-risk patients for outpatients with mild to moderate COVID-19 if they meet criteria for treatment based on EUAs. Most information presented here applies to both counties.

TREATMENT GUIDELINES The guidelines for Therapeutic Management of Nonhospitalized Adults With COVID-19 (bit.ly/3wzr2Em) and Prevention of SARS-CoV-2 Infection (bit.ly/3wBPF3k) have been frequently updated due to changes in prevalence and susceptibilities of current COVID-19 subvariants. With the increased availability of most products, all eligible patients can and should be offered treatment. The NIH Panel currently recommends one of the following (bit.ly/3QW2wpk): • Preferred Therapies (listed in order of preference): - Paxlovid (nirmatrelvir 300 mg plus ritonavir 100mg) orally twice daily for 5 days - Remdesivir IV daily for 3 days • Alternative Therapies ( for use only when neither of the preferred therapies are available, feasible to use, or clinically appropriate – in alphabetical order): - Bebtelovimab 175 mg, administered as a single IV infusion - Lagevrio (Molnupiravir) 800 mg orally twice daily for 5 days The Alameda County PHD recommends two therapeutic locator websites to identify sources of therapeutics and “test to treat” sites: • covid-19-therapeutics-locator-dhhs.hub.arcgis.com • covid-19-test-to-treat-locator-dhhs.hub.arcgis.com For clinical questions about treatment with COVID-19 outpatient therapeutic products, contact Arnie Spanjers, MD, Alameda County Public Health Department, at arnie.spanjers@ acgov.org.

PRE-EXPOSURE PROPHYLAXIS Evusheld is a combination monoclonal antibody that can only be used in high-risk patients who: • Do not have COVID-19 and have not had a recent exposure;

AND Have moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments, and may not mount an adequate immune response to COVID-19 vaccination, OR • Cannot be vaccinated due to a history of severe adverse reaction to a COVID-19 vaccine component.

The FDA has authorized a change in dosing for Evusheld.

Consider repeat dosing every 6 months (300 mg tixagevimab and 300 mg cilgavimab) if patients need ongoing protection. For individuals with a history of severe hypersensitivity reaction to a COVID-19 vaccine, consider consultation with an allergistimmunologist prior to Evusheld administration.

Providers who do not currently receive Evusheld through the HHS Health Partner Portal distribution process can order small, limited quantities (1-3 patient courses) through AstraZeneca.

Call the AstraZeneca Evusheld HelpLine for Providers at 1-833-EVUSHLD or visit the product website (evusheld.com) for more information.

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RECOMMENDATIONS FOR CLINICIANS PRESCRIBING MONOCLONAL ANTIBODIES AND REMDESIVIR The Alameda County PHD recommends that clinicians with patients who meet the inclusion criteria for the use of outpatient MAB therapy or Remdesivir contact the following entities, or other participating medical systems, for information on treatment availability. Treatment should be coordinated in advance of sending a patient for therapy.

• Outpatients: - Physician referral through the patient’s health plan - Total Infusion: totalinfusion.com/make-a-referral (Monoclonal antibodies only) • Long-term Care Facility Residents: Specialty Pharmacy associated with LTCF • If timely appointments in Alameda County are not available for your patients, you can contact the hospitals below: - Stanford Medical Center, Palo Alto (shc.is/3QTXuJS): Contact DL-SHC-Pharmacy-COVID@stanfordhealthcare.org or (650) 391-8503.

- UCSF (bit.ly/3Rc6N7O): Contact OPHoutreachBAMfax@ucsf.edu or (415) 514-7328. For UCSFaffiliated practices only.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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ACCPAC

A program of the Bay Area Medical Societies

Enhance your leadership effectiveness Learn from nationally recognized experts Expand your network with local colleagues Earn a Certificate of Completion and up to 24 hours of CME Credit

Today’s dynamic health care environment requires physicians to be effective leaders to ensure organizational and individual success. The Physician Leadership Program addresses the fact that physicians are, and should be, placed in roles with organizational responsibility, but have limited formal opportunities to learn the concepts, skills, and tools of leadership. This program allows physicians to build upon their clinical leadership experience by honing skills like communicating a vision, motivating colleagues, negotiating with payers, and collaborating across silos in order to build organizations, compete for resources, lead change, influence policy and overcome challenges.

The Physician Leadership Program kicks off in January 2023 with an in-person session in Oakland, followed by four 2-hour virtual sessions led by nationally recognized faculty. Concluding the program, we will reconvene in Oakland for one final in-person session. In addition to these plenary sessions, Dr. Worthen will offer a oneon-one consultation for each participant to focus on their personal leadership goals. The program is sequenced and scheduled to accommodate busy physicians. Participants will gain practical skills and insights directly applicable to their practice opportunities and challenges. Participants can earn a certificate of completion and up to 24 hours of category 1 CME credit.

PROGRAM DATES  January 21, 2023 Oakland  January 31, 2023  February 21, 2023  March 14, 2023  March 28, 2023  April 8, 2023 - Oakland

For additional information, please contact Jennifer Mullins, ACCMA Associate Director of Education & Events, at jmullins@accma.org, or (510) 654-5383.

The ACCMA has transitioned this program to a full scholarship opportunity available to all members.

To participate, complete the online scholarship application at https://bit.ly/3JZlkkW no later than Friday, November 18.

CONTINUING MEDICAL EDUCATION Accreditation Statement: The ACCMA is accredited by the California Medical Association (CMA) to provide continuing medical education Credit Designation Statement: ACCMA designates this live activity for a maximum of 24 hour(s) of AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PHYSICIAN LEADERSHIP PROGRAM

Physician Leadership Program

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he sixth iteration of the regional Physician Leadership Program will begin in January 2023. The program was first developed by physician leaders from the ACCMA in collaboration with faculty from the UC Berkeley School of Public Health and Haas School of Business. Each cohort has experienced a different variation of the curriculum to reflect the current climate in healthcare.

This successful program allows physicians to build upon their clinical leadership experience by honing skills such as communicating a vision, motivating colleagues, negotiating with payers, and collaborating across silos in order to build organizations, compete for resources, lead change, influence policy, and overcome challenges.

The 2023 program will be the first to be offered in a hybrid format over a four-month period. Kicking off with an all-day, in-person Saturday session in Oakland, followed by four 2-hour virtual sessions, the Physician Leadership Program is led by

Hilary Worthen, MD, and nationally recognized faculty. Also new in 2023 are one-on-one consultations with Doctor Worthen for each participant to focus on their personal leadership goals. A final in-person convening in Oakland will conclude the program.

We are excited to announce that the program will be offered as a full scholarship opportunity to ACCMA participants. Physicians seeking to enhance their leadership skills, learn from nationally recognized faculty, network with other Bay Area physicians, and become part of a physician leadership alumni group should apply now.

We are inviting all interested participants to apply for a scholarship to attend the program at no cost at bit.ly/3JZlkkW. Applications are due by November 18. Following our review, participants in the 2023 cohort will be notified by December 15.

For more information, see flyer on opposite page or contact Jenn Mullins, Associate Director of Education and Events at jmullins@ accma.org or (510) 654-5383 x6305.

ACCMA Annual Meeting

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CCMA will be celebrating its history, the achievements of East Bay physicians, and the installation of its 2023 officers— while also raising funds for medical student scholarships—during our Annual Meeting on Friday, November 4 from 6 to 9 p.m. at the Claremont Club & Spa in Berkeley.

Over the decades, the Annual Meeting has served as a fun and entertaining evening during which the East Bay health care community can connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s program is packed with an engaging guest speaker, highlights of local physician accomplishments, and poster presentations from previous student scholarship winners.

We are excited that this year’s keynote speaker is Keena Turner, legendary #58, and 4-time Super Bowl champion for the San Francisco 49ers. He will join us to discuss sportsmanship,

teamwork, the championship mindset, and what it took to win and sustain dominance during his 11-year professional football career. Now, as Vice President and Senior Advisor to the General Manager of the 49ers, Keena is a pillar in the community and supports several organizations focusing on our community’s youth.

ACCMA is now accepting sponsorships from medical staffs, practice groups, hospitals, and health care advocates who would like to support or attend this year’s event. The Sponsor level includes a table for 10 and acknowledgment in the ACCMA Bulletin, which is sent to about 5,200 physicians. A substantial portion of your sponsorship is tax deductible. Please contact Jennifer Mullins, ACCMA Associate Director of Education and Events, at jmullins@accma.org or (510) 654-5383 to reserve your table today. You can also contact her for individual tickets or purchase tickets online by going to www.accma.org/events. We look forward to seeing you on November 4!

Join the ACCMA at www.accma.org/membership/join-now ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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AMA NO SURPRISES TOOLKIT

Do Do youyou want want to improve to improve physician physician health health andand professional professional satisfaction satisfaction in your in your organization organization butbut don't don't know know where where to start to start or what or what step step to take to take next? next?

JoinJoin a roundtable a roundtable of your of your colleagues colleagues – more – more thanthan 60 leaders 60 leaders from from medical medical groups, groups, staffs, staffs, residency residency programs, programs, andand other other physician physician organizations organizations – to– to hospital hospital medical medical learn learn andand share share howhow to apply to apply the the organizational organizational culture culture andand practice practice changes changes thatthat reduce reduce physician physician burnout burnout andand drive drive professional professional fulfillment. fulfillment.

Here's Here's howhow the the BayBay Area Area Physician Physician Wellness Wellness Collaborative Collaborative cancan support support youryour wellness wellness efforts: efforts: Collaborate Collaborate withwith other other wellness wellness leaders leaders on aonhighly a highly structured structured roadmap roadmap to make to make substantive substantive changes changes thatthat cancan fundamentally fundamentally change change the the practice practice environment environment in in youryour organization. organization.

Refine Refine andand customize customize initiatives initiatives thatthat will will have have the the greatest greatest impact impact on improving on improving physician physician wellness wellness for the for the least least amount amount of time of time andand costcost – no– matter no matter youryour practice practice sizesize or resource or resource limitation. limitation.

Receive Receive expert expert guidance guidance andand resources resources from from Program Program Director Director Paul Paul DeChant, DeChant, MD.MD. In addition In addition to bimonthly to bimonthly meetings, meetings, virtual virtual office office hours hours will will be held be held every every other other month. month.

We We invite invite youyou to join to join ourour efforts efforts to restore to restore joy joy to the to the practice practice of medicine, of medicine, together. together.

To To request request an an invitation invitation to enroll, to enroll, visit visit https://bit.ly/3PcTd3L https://bit.ly/3PcTd3L If you If you have have anyany questions questions or would or would like like more more information, information, please please contact contact MaeMae Lum, Lum, ACCMA ACCMA Deputy Deputy Director, Director, at (510) at (510) 654-5383 654-5383 or mlum@accma.org. or mlum@accma.org.

WELLNESS COLLABORATIVE

The Bay Area Physician Wellness Collaborative is led by Dr. Paul DeChant, a nationally recognized physician wellness expert with a background in practice redesign and organizational change.

Following the Stanford Model for Professional Fulfillment, the three areas of focus for driving organization-wide progress are: 1. Personal Resilience – individual skills, behaviors, and attitudes 2. Efficiency of Practice – workplace systems, processes, and practices 3. Culture of Wellness – organizational work environment, values, and behaviors

These areas of focus will be covered in the following sample roadmap:

Dr. Paul DeChant is an experienced physician executive with more than 25 years of clinical and management experience in all aspects of medical group leadership.

From 2009–2014, he served as CEO of Sutter Gould Medical Foundation. He led a management system and culture transformation based on the theme of “Returning Joy to Patient Care,” which achieved the highest levels of provider and patient satisfaction in Sutter Health, improved physician satisfaction from the 45th to 87th percentile, and was recognized as the highest rated in overall care among 170 California medical groups two years in a row.

September 13, 2022: Wellness Leader – Q&A with guest speaker Gaurava Agarwal, MD, CWO at Northwestern Medicine, on the variety of forms that a wellness leader role can take depending on the size, nature, and resources of the organization.

November 15, 2022: Center/Committee for Physician Wellbeing – Build self-care support systems, peer support resources, mental health referrals and consultation services, life-needs support mechanisms, and other comprehensive wellbeing resources.

January 10, 2023: Peer Support/Burnout Coaching – Examine different options for providing evidence-based support for physicians, reviewing how each approach provides unique value based on the needs of the individual and organization.

March 7, 2023: Get Rid of Stupid Stuff (GROSS) – Reclaim up to 3 hours a day by getting rid of poorly designed, unnecessary, or burdensome work, and identifying administrative tasks that a non-physician team member can handle.

May 9, 2023: Diagnostic Assessments – Explore the variety of wellness and burnout surveys available to help an organization choose the right survey for its needs.

July 11, 2023: EHR Optimization – Consider approaches to optimizing the EHR, including innovations that significantly reduce documentation burden and in-basket overwhelm.

September 12, 2023: Daily Huddles – Reimagine the daily huddle process and how it specifically addresses key drivers of burnout; provide a guide to get started or to improve a huddle process that is currently in place.

November 14, 2023: Organizational Compacts – Examine how organizational values guide the vision and mission statements for physician organizations, and how compacts can support a clinical environment for physician success and quality care for patients.

DATA EXCHANGE FRAMEWORK

(continued from page 11)

lays out practices’ responsibility to comply with the HHS Data Exchange Board (see below).

3 HHS Data Exchange Board: The State has proposed to create a 5-to-7-member governing body that will oversee data exchange in California. This board will be charged with overseeing and updating the Data Sharing Agreement, ensuring compliance with the DxF, and qualifying health information organizations. The details about this board will be included in a legislative proposal that will be introduced next year.

4 Technical Assistance for Small and Safety Net Practices: The 2022-23 State Budget included $50 million for providing technical assistance to small practices and other safety net providers. As of the writing of this article, there are no additional details to share. CMA is in actively engaged in ensuring that the funding will reach physician practices quickly and efficiently, to help them prepare for the DxF. For more details on these components, CMA members can access the CMA DxF Fact Sheet on the CMA website (see below).

TIMELINE A general timeline for the Data Exchange Framework is listed below: DATE

REQUIREMENT

January 31, 2023

All health and human services organizations (including physician practices) must execute the Data Sharing Agreement

January 31, 2024

Most health care providers must implement the Data Exchange Framework

January 31, 2026

Small and safety net practices (see above) must implement the Data Exchange Framework

medical group or an IPA, a good place to start is by contacting that entity to inquire about their plans for compliance with the Data Exchange Framework. If you get access to an EHR system or population health platform through the group or IPA, and they already engage in data exchange, an individual practice may not need to sign their own DSA. The organization will sign the Data Sharing Agreement on your behalf, and data exchange will be handled at that level.

For more independent practices, now is a good time to familiarize yourself with the health information organizations (HIOs) that serve your community. Members of the California Association of Health Information Exchange (ca-hie.org/about/ members) represent the largest and most well-established HIOs in the state. They have already signed an agreement to work together. As more entities become aware of the requirements of the DxF, lead times to sign up with an HIO may become longer; it will help to approach them soon.

Finally, be sure to work with your EHR vendor, especially if you work with a smaller, specialty system. These systems can require custom interfaces to onboard to an HIO, which can be both time-consuming and costly. On the plus side, some EHRs connect through a national data sharing network, allowing you to comply without adding a new vendor. Either way, it helps to include your EHR vendor early and often.

ACCMA AND CMA RESOURCES • Online briefing on the Data Exchange Framework (recorded June 28, 2022): youtube.com/c/CMAdocs.

• CMA Fact Sheet for physician members (bit.ly/3RkgbXb) summarizes the requirements and components of the DxF and includes FAQs that will be updated regularly.

• Call the ACCMA at (510) 654-5383 or the CMA Member Helpline at (800) 786-4262.

Practices are required to execute (sign) the Data Sharing Agreement in just a little over four months from the writing of this article. The state has not yet announced how that process will take place, so please watch for further announcements from CMA or the State of California. In addition, it is important for physicians to know that they must sign the agreement by January 31, 2023, even if their practice is small enough to be in the cohort that does not have to comply until 2026.

WHAT PRACTICES CAN DO NOW With these new requirements being phased in over the next four years, practices will want to get started on building their game plan for compliance as soon as possible. If you participate in a

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

To place a classified ad, go to www. accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383.

ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.

DOBBS DECISION

Abortion Laws and How Physicians Can Protect Themselves By the Medical Insurance Exchange of California (MIEC)

Note: MIEC recognizes that the language used to describe abortionrelated care is politically and culturally sensitive. In this article, we have striven to use clinically accepted terminology and directly quoted statutory language where applicable.

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he recent decision by the U.S. Supreme Court in the case of Dobbs v. Jackson Women’s Health Organization held that the Constitution of the United States does not confer a right to abortion, effectively remitting abortion rights and restrictions to the state level. In this article, we lay out the state abortion laws in California, including changes resulting from the Dobbs decision; explore the ripple effects of the decision; and provide physicians with guidance to protect themselves.

Following is a partial summary of abortion laws in California.

For a summary of laws specific to minors and parental notification and/or consent, please see “Parental Involvement in Minor Abortions” at bit.ly/2HsVlE1.

CALIFORNIA ABORTION LAWS Abortion is legal in California up to the point of fetal viability, and it may be performed past that point in cases where the mother’s life or health is endangered.

• On June 24, Governor Gavin Newsom signed AB 1666 into law. This law declares other states’ laws allowing civil actions arising from abortions to be contrary to California public policy, thus preventing the application of case law or the enforcement of out-of-state judgments within California.

• Pending bills in the state legislature related to abortion include: - AB 2091: Protection of medical privacy to prevent patients from being compelled to testify or provide information in an out of state investigation or action related to abortion - AB 2223: Removing requirement for coroner to investigate fetal deaths after 20 weeks gestation - AB 2626: Prohibition on medical and nursing board suspension/revocation of a license solely for performing an abortion • In November 2022, California voters will decide whether to enshrine the right to abortion and contraception in the state

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Constitution (Proposition 1).

California joined Oregon and Washington in the Multi-State Commitment to Reproductive Freedom, which includes, among other pledges, a refusal of “extradition of individuals for criminal prosecution for receiving legal reproductive healthcare services in our states.”

FEDERAL GOVERNMENT RESPONSE AND EMTALA The Biden Administration has taken steps to preserve access to care in the wake of the Dobbs decision. Most notably, on July 8, President Biden issued an Executive Order protecting access to reproductive healthcare services and subsequently, HHS issued a statement reaffirming physician requirements under Emergency Medical Treatment and Active Labor Act (EMTALA).

Under EMTALA, an “emergency medical condition” is defined as “medical conditions with acute symptoms of sufficient severity that, in the absence of immediate medical attention, could place the health of a person (including pregnant patients) in serious jeopardy, or result in a serious impairment or dysfunction of bodily functions or any bodily organ. Further, an emergency medical condition exists if the patient may not have enough time for a safe transfer to another facility, or if the transfer might pose a threat to the safety of the person.”

In its statement, HHS clarified that abortion is one of the required stabilizing treatments under EMTALA and confirmed that EMTALA requirements preempt any state laws banning abortions – even if there are no exceptions for emergency care, or if emergency care is more narrowly defined under state law. On August 2, the U.S. Department of Justice filed a lawsuit challenging Idaho’s SB 1385, arguing that the prohibition of abortions except for life-saving treatment would violate EMTALA’s requirement to perform abortions in other emergency situations. Importantly, HHS has also issued guidance on HIPAA and disclosures of information relating to reproductive health care (bit.ly/3RidlBE).

TELEMEDICINE AND PATIENTS SEEKING OUT-OF-STATE CARE Questions have arisen around how disparate state laws will be continued on page 20 ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

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DOBBS DECISION

(continued from page 19)

navigated when patients travel to other states to receive reproductive or abortion-related care, or when a physician licensed in multiple states prescribes medication for purposes of abortion via telemedicine.

Some states are seeking not only to prohibit abortion within state jurisdictions, but also to prohibit citizens from obtaining outof-state abortions. For example, Missouri advanced a proposal to allow private citizens to sue Missouri residents who undergo an abortion outside the state, as well as their providers and anyone else who assists them in seeking an abortion. Similarly, Texas has enacted a six-week ban on abortion with a private right of action enabling individuals to sue abortion providers and others. This has caused concerns amongst physicians in states where abortion is still legal, in terms of their legal liabilities.

As noted above, California has committed to providing legal protection for physicians providing care and patients coming to this state for care. Other care providers have taken a different approach. Planned Parenthood of Montana has ceased providing medication abortions to patients traveling from out of state due to concerns that patients taking the medication in their home state will be violating state law.

In 2021 the FDA authorized the medications Mifepristone and misoprostol to be prescribed via telemedicine and mailed to the patient for the termination of pregnancies of less than 10 weeks gestation. Currently, nineteen states (not including AK, CA, HI, or ID) have laws in place restricting access to such medications by mail. A Louisiana law makes “delivering, dispensing, distributing, or providing” an “abortion-inducing drug” to a pregnant person in Louisiana a crime punishable by fines and imprisonment, raising questions on how such a law will be enforced if the prescribing provider resides outside of the state. The U.S. Attorney General issued a statement advising that states cannot ban mifepristone based on disagreement with the federal government on its safety and efficacy (bit.ly/3Kow0cQ).

HOW CAN PHYSICIANS PROTECT THEMSELVES? At this point, there is much that is still unclear; the legal landscape around abortion is still changing both at the federal and state level, and clinical guidance is still being developed. Therefore, it is important for physicians to follow ongoing changes, look to the most authoritative sources for guidance, and know how and when to ask for assistance in specific situations. MIEC recommends the following.

Keep up to date with developments in state and federal law.

Physicians practicing in states currently allowing abortion should continue their current practice, while remaining vigilant of any 20

future changes in the law. However, physicians who practice in multiple states, either in person or through telehealth, should be aware of and compliant with the laws in each state in which patients are located at the time of treatment. Furthermore, physicians treating patients who travel from out-of-state should consider potential legal liabilities across state lines.

Follow available clinical guidance. MIEC recommends that physicians remain vigilant of and continue follow any formal guidance offered through the government and/or professional organizations. The American College of Obstetrics and Gynecology (ACOG) has issued multiple statements since the Dobbs decision (bit.ly/3ctvgXt), but there has been little clinically specific guidance offered, most notably around the issue of how physicians should balance life-saving care with state prohibitions on abortion. On July 13, ACOG issued a statement on the clarification of EMTALA protections (bit.ly/3Ku7SG2), in which it acknowledged that the clarification of EMTALA protections should reassure physicians that they will be protected when providing evidence-based emergency medical care, without fear of state bans on abortion.

The American Academy of Emergency Physicians also released a statement in response to the Dobbs decision (bit. ly/3coYQNT) and is seeking to provide guidance to physicians providing emergency care (bit.ly/3CKhJ8u).

The most recent formal guidance was published by CMS on July 11; this updated guidance addresses how EMTALA applies to pregnant patients (go.cms.gov/3R2stDS). With regards to specific conditions and treatments, CMS states the following: Emergency medical conditions involving pregnant patients may include, but are not limited to: ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features.

Stabilizing treatment could include medical and/or surgical interventions (e.g., methotrexate therapy, dilation and curettage (D&C), removal of one or both fallopian tubes, antihypertensive therapy, etc.).

Regardless of the specific clinical guidance or state-specific laws around abortion, physicians should always carefully document patient care including history and exam findings, informed consent, and indications for treatment. Good documentation will greatly facilitate the defense of any claim by providing evidence of medical decision-making.

Contact MIEC for assistance. MIEC is committed to protecting its members in this rapidly changing legal environment.

Physicians who are concerned about specific situations and their associated liability risk, or who are concerned about a potential claim arising from providing reproductive health services to a particular patient, should contact MIEC for assistance.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CLIMATE CHANGE POLICY

ACCMA Climate Change Policy The ACCMA Council adopted the following policy at its May meeting to guide ACCMA advocacy on climate change.

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he Alameda-Contra Costa Medical Association (ACCMA) represents over 5,400 East Bay physicians, medical students, and physicians in training, who are responsible for providing medical care to and supporting the wellbeing of the residents of Alameda County and Contra Costa County. The mission of the ACCMA is to promote the science and art of medicine, the care and well-being of patients, the protection of the public health, and the betterment of the medical profession.

According to the World Health Organization, “Climate change is already impacting health in a myriad of ways, including by leading to death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disruption of food systems, increases in zoonoses and food-, water- and vector-borne diseases, and mental health issues. Furthermore, climate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, low-income communities, migrants or displaced persons, older populations, and those with underlying health conditions.”1 Climate change is one of the greatest public health threats we are facing in the 21st century and is already having a significant negative impact on the public health and wellbeing of patients in our own community. As a professional association of physicians, the ACCMA is principally focused on policy aspects of climate change that directly impact the health of our patients and community and about which our members have expertise. In broad terms, the ACCMA believes the following climate change-related policy interventions will improve the health of our patients and community: • Transitioning to clean, safe, and renewable energy; and energy efficiency and reducing anthropogenic greenhouse emissions • Providing access to safe and affordable drinking water and a sustainable water supply • Ensuring safe and healthy air quality • Supporting the development of healthy communities by investing in safe walking, bicycling and street infrastructure and providing safe and affordable public transit options • Creating healthy, sustainable, and resilient food systems

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Ensuring fair employment and economic opportunities for workers and communities adversely impacted by climate change and the transition to a low-carbon economy Eliminating racial and economic disparities among communities bearing disproportionate environmental costs, like more lead, particulate air pollution, ozone smog and other health hazards in the places people live, work and play Treating climate change as a public health emergency Preparing our healthcare system to manage the health consequences of extreme heat, powerful storms and floods, yearround wildfires, droughts, and other climate-related events, especially those which result in population disruption and population displacement Implementing policies at the practice-level to mitigate climate change, implement environmentally sustainable and energy-efficient practices, and prepare for the impacts of climate change on patient health and clinical operations Funding for climate change research to understand, adapt to, and mitigate the human health effects of climate change

Questions/comments may be directed to the ACCMA at accma@accma.org or (510) 654-5383.

Note 1 World Health Organization, October 30, 2021: https://www.who.int/newsroom/fact-sheets/detail/climate-change-and-health

NOVEMBER ELECTIONS (continued from page 10) requirements so that patients are ensured timely access to the evidence-based, quality health care they need.

Inflation Reduction Act. We support the Inflation Reduction Act that was signed by President Biden. The legislation includes important and historic changes for our patients. It will reduce Medicare’s unsustainably high prescription drugs costs, ensure continued availability of affordable health care coverage for millions of Californians under the Affordable Care Act (ACA), and address the devastating impact of climate change on public health.

If you have any questions or want more information, please contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives at dlopez@accma.org or (510) 654-5383, ext. 6320.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

21

NEW & RETURNING MEMBERS

Brad Buchman, MD, Family Practice, UC Health

Audreyandra Imansjah, DO, Family Practice, San Ramon

Sarah Rahman, MD, Internal Medicine, Alameda Health System

Chew May Cheah, MD, General Medicine, TPMG Richmond

Michael O’Neal, MD, Emergency Medicine, TPMG Walnut Creek

Christopher Walker, MD, Internal Medicine, TPMG Oakland

Anne Foster, MD, ObstetricsGynecology, UC Health

Kelly Pfeifer, MD, Family Practice

Faye Yu, MD, General Surgery, TPMG San Leandro

WELCOME, BROWN & TOLAND PHYSICIANS! Douglas Abeles, MD Daniel Abelson, MD Pacita Aducayen, MD Josephine Agbowo, MD Anurag Agrawal, MD Hina Ahmad, MD Jeanie Ahn, MD Rajiv Ahuja, MD Michael Ajuria, MD Chika Akera, MD Haseeb Al-Mufti, MD Mehrnoosh Almassi, MD Kasra Amirdelfan, MD Robert Amster, MD Jennifer An, MD Amar Anand, MD Shilpi Anand, MD Lucille Andersen, MD Jennifer Anderson, MD Lisa Arcilla, MD Jose Arias Vera, MD Audrey Arzamendi, MD Alex Aslan, MD Joshua Au, MD Michael Austin, MD Norman Banks, MD Manasi Bapat, MD Gregory Barme, MD Sherilyn Baughman, MD Eric Bava, MD Barbara Beach, MD Gary Bean, MD Edward Van Becker, MD David Bell, MD Barbara Benzwi, MD David Berke, MD Margarita Berrios, MD Maria Bhaijee, MD Amitabh Bharadwaj, MD Alok Bhattacharyya, MD Julia Bley, MD Ernest Bloom, MD Suzanne Bodor, MD John Bokelman, MD Navjeet Boparai, MD Jeffrey Bortz, MD Barbara Botelho, MD David Bradshaw, MD Joseph Brandel, MD Melody Brewer, MD Jenna Brimmer, MD Daniel Brinton, MD Adam Brooks, MD Candida Brown, MD Michael Brown, MD Adrianna Browne, MD John Bry, MD

22

Marina Bulatov, MD Jeffrey Burack, MD Benjamin Busfield, MD Olivia Butt, MD Clarisse Cadang, MD Rodolfo Cadang, MD Kenneth Caldwell, MD John Call, MD Kendell Cannon, MD Brazell Carter, MD Kimberly Ceci, MD Mandeep Chadha, MD Less Chafen, MD Dev Chahal, MD Harvind Chahal, MD Premjit Chahal, MD Elaine Cham, MD Clayton Chan, MD Mark Chan, MD Sue Chan, MD Anita Chang, MD David Chang, MD Gwendolen Chang, MD Heidi Chang, MD Kimberly Chang, MD Kenneth Chao, MD Paul Chard, MD Christina Chavez-Johnson, MD Varun Chawla, MD Qi Che, MD Benjamin Chen, MD Henry Chen, MD Jeff Chen, MD Ji Jill Chen, MD Kwan Chen, MD,FACC,MPH Steven Chen, MD Tammy Chen, MD William Chen, MD Xiaochuan Chen, MD Xiaoshuang Chen, MD Christi Cheng, MD Huilan Cheng, MD Joseph Cheng, MD Paul Cheng, MD Susan Cheng, MD Suraj Cherry, MD Ka Cheung, MD Brian Chin, MD Catherine Chin, MD Douglas Chin, MD Jonathan Chin, MD Cynthia Chiu, MD Harneet Chopra, MD Tina Chou, MD William Chow, DO George Chu, MD Taylor Chung, MD

Philip Chyu, MD Juliana Cinque, MD Rebecca Citron, MD Ronald Cohen, MD Susie Cohn, MD Gerald Collins, MD Christian Conderman, MD Patricia Conolly, MD Christina Corey, MD Mario Corona, MD Anastasia Coutinho, MD Beth Cowan, MD Kevin Critchlow, MD Joel Crockett, MD James Crook, Jr., MD Natalie Cvijanovich, MD Katherine D’harlingue, MD Leonardo Dacanay, MD Frances Dalton, MD Juliana Damon, MD Minh-Ngoc Dang, MD Bay Dang-Vu, MD Earl Darby, MD Neesha Dave, DO Alyson Davidson, MD Sally Davis, MD Sharon De Edwards, MD Lilia De Jesus, MD Darrow De Luca, MD Jennifer De Niro, MD Michael Deboisblanc, MD Jordan Deschamps-Braly, MD Christin Destefano, MD Barbara Devane, DO Deepak Dhawan, MD Rafael Diaz Flores, MD Ole Dierks, MD Clement Donahue, MD Rakesh Donthineni, MD Warren Dotz, MD Robert Doud, MD T. Eric Drasin, MD Kathryn Drinkard, MD Golde Dudell, MD Kimberly Duir, MD David Durand, MD Benjamin Durant, MD John Edelen, MD Magdalen Edmunds, MD Kasra Eliasieh, MD Robert Elliott, MD Selena Ellis, MD Ronald Elson, MD Louis Enrique, MD Jose Enz, MD Robert Eppley, MD Mark Escajeda, MD

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Maria Escalada, MD Clemens Esche, MD Alex Espinoza, MD Thomas Eusterbrock, MD Tracy Evans-Ramsey, MD Uchechukwu Ezeh, MD Michael Faer, MD Iryna Falkenstein, MD Sassan Falsafi, MD Ming Fang, MD Susan Fang, MD Farinaz Farrahi, MD Aamir Faruqui, MD Naseem Fatima, MD Vahid Feiz, MD Susan Ferguson, MD Dionisio Fernandes, MD James Feusner, MD Carl Fieser, Jr., MD Mark Finch, MD Charles Fiske, MD Timothy Fitzer, MD Laravic Flores, MD Rachel Fogel, MD Karen Fong, MD Lloyd Ford, MD Zuzana Foster, MD Patricia Francis, MD Jonathan Frank, MD Linda Frankel, MD Orrin Franko, MD Ingrid Freeny, MD Lily Friedman, MD Yaron Friedman, MD Jessica Furer, MD Sangeeta Gambhir, MD Renu Gandhe, MD Anupama Ganga, MD Karna Gendo, MD Barsam Gharagozlou, MD Hussain Gilani, MD Katherine Gilbert, MD Carol Glann, MD Erica Glenn, MD Carla Golden, MD Mona Goldfine, MD Michael Goldrich, MD Esha Gollapalle, MD Merry Gong, MD Julie Goo, MD Linda Gordon, MD Karen Graham, MD Douglas Grant, MD David Green, MD Trinh Green, MD Robert Greenberg, MD Robert Greene, MD

Navjot Grewal, DO Suneet Grewal, MD Emily Guh, MD Tanya Gupta, MD Erin Gutierrez, MD Jaimish Gwalani, MD Fadi Haddad, MD Joanna Halkias, MD Michael Hall, MD Ali Hamraz, MD James Han, DO Sarah Handelsman, MD Ted Handler, MD Nadine Hanna, MD Claire Hargrove, MD Steven Harrison, MD Stephen Hart, MD Jacquelyn Haskell, MD Maurine Heard, MD Michael Hebrard, MD Robert Heidersbach, MD Ileana Helms, MD Juliana Herbert, MD Lisa Higa, MD Viet Huy Ho, MD Victorina Hoffmann, MD Melanie Hom, MD Eitan Homa, MD Kenneth Honsik, MD Kelly Hood, MD Brian Hopkins, MD Carolyn Hoppe, MD Rupert Horoupian, MD Mehra Hosseini, MD James Howard, MD Kenneth Hsiao, MD Kun Huang, MD Rong Huang, MD Xiaoguang Huang, MD Floyd Huen, MD Michelle Huffaker, MD Thomas Hui, MD Melvin Huie, MD Sarbjit Hundal, MD Emily Hunter-Adamson, MD Said Ibrahimi, MD Devika Icecreamwala, MD Claudia Iota-Herbei, MD Joshua Jacobs, MD Sanjeev Jain, MD Amir Jamali, MD Akbar Jamall, MD Babak Jamasbi, MD Adrian James, MD Benjamin Jarrahi, MD Kirk Jensen, MD continued on page 24

ALAMEDA ALLIANCE

Addressing Food Insecurity with Recipe4Health

By Scott Coffin, Alliance CEO

A

lameda Alliance for Health (the Alliance) is proud to serve over 320,000 children and adults in Alameda County. In this article, you will read about the newest Community Support service that the Alliance is offering to eligible members, and which will address food insecurity while improving the physical and behavioral health of our most vulnerable residents.

During the past year, the Alliance has worked diligently to meet the requirements needed to implement major components of the Department of Health Care Services’ (DHCS) CalAIM initiative. We are proud to have successfully launched new enhanced care management and community supports services, and the transition of major organ transplants into Alameda County’s Medi-Cal managed care program. These essential services, along with other CalAIM initiatives, are helping improve the health outcomes of our members, particularly those with the most complex health care needs.

Earlier this year, the Alliance introduced six Community Supports services, including housing transition and tenancy services, recuperative care, asthma remediation, and medically tailored meals/food. These services, while not medical in nature, are major factors in social determinants of health that are helping our members avoid hospital stays, reduce visits to the emergency department, and improve their overall well-being.

Beginning in September, the Alliance launched the Recipe4Health program, as part of our medically tailored meals/ food program. Recipe4Health is a ‘food as medicine’ program administered by the Alameda County Health Care Services Agency (HCSA) as part of the ALL IN program. Recipe4Health aims to address social drivers of health among residents by prescribing patients’ nutrient-dense produce and connecting them to local support groups that brings members together and includes physical activities, healthy food demonstrations, stress reduction, and social connection over the course of several months.

Through our partnership with the Alameda County, eligible Alliance members will have access to food prescriptions, which includes up to twelve weeks of a wide selection of healthy vegetable alternatives. We are proud to note that the food prescriptions

are filled by Dig Deep Farms – a social enterprise founded in 2010 by the Deputy Sheriffs’ Activities League and the Alameda County Sheriff ’s Office – and local urban farm that creates green economy jobs for justice-involved individuals.

We know that lack of access to healthy foods are associated with poor health, leading to higher health care costs. A study funded by U.S. Health & Human Services found that unhealthy eating habits cost the U.S. health care system about $50 billion per year; these costs are associated with heart disease, stroke, and type 2 diabetes. As a safety net provider, our mission is to improve the health and well-being of our members by collaborating with our provider and community partners to deliver high-quality and accessible services, and the Recipe4Health program does just that.

Through this important partnership, we hope to address poor health outcomes that are associated with food insecurity that our members face on a regular basis, to support the needs of our most complex and vulnerable patients, assist with the management of chronic health conditions, and reduce hospitalizations.

Patients who qualify for this service must meet at least one of the following criteria to be eligible: • Have chronic condition(s), such as but not limited to diabetes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, human immunodeficiency virus (HIV), cancer, gestational diabetes or other high-risk perinatal conditions and chronic or disabling mental/behavioral health disorders.

• Is being discharged from the hospital or a skilled nursing facility or at high risk of hospitalization or nursing facility placement.

• Have intensive care coordination needs.

Since 2020, the Alliance has financially invested in the Recipe4Health program and partnered to help launch and expand Food as Medicine efforts at local clinics throughout Alameda County. Through this partnership, thousands of patients continued on page 24 ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

23

ALAMEDA ALLIANCE

(continued from page 23)

throughout Alameda County have been screened for food insecurity and have been offered healthy food interventions in combination with group behavioral support that have led to improved health outcomes. The integration of Recipe4Health into the Alliance’s Community Supports medically tailored meals/ food program will address the nutritional needs of the Alameda County community while reducing barriers associated with food insecurity. If you have any questions about this medically supportive meals/food service, please contact the Alliance’s Community Supports Team at CSDept@alamedaalliance.org.

ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 310,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

PRESIDENT'S PAGE (continued from page 7)

individual’s right to reproductive freedom and to use and refuse contraception. Page 19 in this issue provides guidance to physicians on protecting themselves against out-of-state abortion laws.

Speaking of the upcoming November election, our Legislative Committee was also busy this year interviewing candidates for local office and sharing our impressions with CALPAC and ACCPAC, our political action committees that provide financial support to physician-friendly candidates. In our area, CALPAC is supporting Lily Mei for Senate District 10 and Shawn Kumagai for Assembly District 20, and ACCPAC is dually supporting Rebecca Kaplan and Lena Tam for Alameda County Board of Supervisors District 3 and Debra Allen for Contra Costa Board of Supervisors District 2.

These are just some of the many activities ACCMA has been

involved in over the past year in its efforts to empower and organize physicians to lead and improve the practice of medicine so as to better patients’ lives and the community’s health. ACCMA is a remarkable organization, and I have been honored and extremely proud to serve as your President. I would like to thank you, our members, for your continued to support of ACCMA and CMA. I would also like to thank the scores of members who take time out of their busy lives to serve on the ACCMA Council, the District IX Delegation, and on our many committees for your many contributions to the betterment of medicine. Finally, I would like to congratulate our incoming President, Doctor Edmon Soliman.

Having worked with Edmon, I am confident that he will do a great job, and I wish him and the other officers the best of luck in the coming year.

NEW MEMBERS (continued from page 22) Valerie Jerdee, MD Jenny Jew, MD Matthew Johnson, DO Sara Johnson, MD Ilisten Jones, MD Sharon Jones, MD Derek Jue, MD Elmer Jumig, MD Jesse Jung, MD Stephen Kahn, MD Lisa Kalar, MD Ruben Kalra, MD Leena Kamat, MD Neil Kamdar, MD Toral Kamdar, MD Bamidele Kammen, MD Richard Kamrath, MD Deepika Kancherla, MD Amy Kane, MD

24

Gail Kang, MD Young Min Kang, MD Lily Kao, MD Sabiha Karakas-Rothey, MD Kate Kasberger, MD Samali Kasozilubega, MD Michael Kassels, DO Jaspreet Kaur, MD Ramandeep Kaur, MD Kerry Kay, MD Varujan Keledjian, MD Brian Kellert, DO Kanwar Kelley, MD Barry Kerman, MD Brian Keyashian, MD Jagmohan Khaira, MD Oliver Khakmahd, MD Anna Khananian, MD Dorothy Khong, MD

Hamidreza Khonsari, MD Edward Kim, MD Kenneth Kim, MD Teresa Kim, MD Nadine Kindy-Baillot, MD James Kong, MD Alexander Kopelnik, MD Rao Kosaraju, MD Nisreen Kothari, MD Kristina Kramer, MD Jennifer Krasnoff, MD Rachel Kreps-Falk, MD Michael Krosin, MD Calvin Kuan, MD Michael Kubalik, MD Pradeep Kumar, MD Steven Kurtzman, MD Regis Kwo, MD Eric Lai, MD

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Ashutosh Lal, MD Hon-Wai Lam, MD Julia Lam, MD Maggie Lam, MD Arthur Lande, MD Olivia Lang, MD Dawud Lankford, MD Nicole Learned, MD Chi Keung Lee, MD Christopher Lee, MD Diane Lee, MD Do-Eun Lee, MD Elaine Lee, MD George Lee, MD Jennifer Lee, MD Christine Lee, MD Mark Lee, MD Peter Lee, MD Scott E. Lee, MD

Scott S. Lee, MD Erica Leigh, MD Shanti Leon Guerrero, MD Craig Leong, MD Dimitry Lerner, MD Jessica Leung, MD Man Kong Leung, MD Jennifer Levy, MD Tsung Tsuan Li, MD Esther Li-Bland, MD Sai-Woon Liang, MD Melissa Liebowitz, MD Kenneth Lien, MD Suzy Lim, MD David Lin, MD Eduardo Lin, MD Eugene Lit, MD Vanessa Litman, MD Ben Littlejohn, III, MD

NEW MEMBERS

William Littman, MD Rock Liu, MD Susan Lo, MD Timothy Lo, MD Yuriria Lobato, MD Matthew Lodewick, MD Evelyn Loo, MD Benjamin Loos, MD Eugene Lowry, MD Peter Lunny, MD Kristelle Lusby, MD Hnoukaj Lyfoung, MD Daveena Ma, MD Padmavathi Madathanapalli, MD Kalyani Maganti, MD Terry Maher, MD Michael Maiman, MD Abid Majid, MD Shreyas Makwana, MD Navin Mallavaram, MD Veena Manjunath, MD Jeffrey Mann, MD Stuart Mansfield, MD Michael Marchiano, MD Leanne Marcotrigiano, MD Andres Marin, MD Jeffrey Mark, MD Ken Marriner, MD Kenneth Martin, MD Sean Martin, MD Joseph Marzouk, MD Patricia Maska, MD Jason Massa, DO Alison Matsunaga, MD Helen Matthews, MD Peter Mazolewski, MD Collins Mbanugo, MD Camilla McCalmont, MD Thomas McBride, MD Rebecca McEntee, MD Brian McGuinness, MD Oscar McKinley, MD Eugene McMillan, MD Barbara McQuinn, MD David Mead, MD Yuyang John Mei, MD Kanwal Merchant, MD Stephen Merjavy, MD Maxwell Merkow, MD Nathalie Michaud, MD Christopher Michel, MD Katrina Michel, MD Jennifer Michlitsch, MD Nick Mickas, MD Jennifer Miller, MD Terina Miller, MD Andrew Min, MD Sourjya Misra, MD Lisa Montang, MD Brendan Morley, MD Ellen Morrissey, MD Dominika Motas, MD Rex Moulton-Barrett, MD John Mouratoff, MD Jason Moy, MD

Janice Moyer, MD Nancy Mozelsio, MD Cynthia Mullen, MD Luisa Munoz Del Romeral, MD Anjali Murthy, MD San-San Myint, MD Frederick Nachtwey, MD Rajiv Nagesetty, MD Enoch Nam, MD Subhendu Narayan, MD Lynne Neumayr, MD Clark Neuwelt, MD Vivienne Newman, MD Christina Ng, MD Hien Nguyen, MD Mychi Nguyen, MD Suzanne Nguyen, MD Thi Nguyen, MD Ann Nguyen-Traxler, MD Jaleh Niazi, MD Michael Nickas, MD Kalamaoka’aina Niheu, MD Michael O’Connor, MD Patricia O’Connor, MD Julie O’Melveny, MD Emily O’Rourke, MD Daniel Oberlin, MD Gonzalo Obnial, MD Lilia Oceguera, MD Rose Ochieng, MD Golaun Odabaei, MD Iqbal Omarali, MD Omoniyi Omotoso, MD Roy Orden, MD Xaviera Ortiz Soto, MD Fernando Otero, MD Eric Padua, MD Anthony Padula, MD Maria Pagtalunan, MD Jianqiu Pan, MD Shu Pan, MD Michael Park, MD Jennifer Parma, DO Bijal Patel, MD Chirag Patel, MD Swati Patel, MD Vikas Patel, MD Wendy Patton, MD Margaret Payne, MD David Perlada, MD Cornelia Pessoa, MD John Peterson, MD An Tan Pham, MD Varinder Phangureh, MD Tracy Phillips, MD Matthew Piazza, MD Courtney Pickering, MD Elaine Pico, MD Andrew Pienkny, MD Joel Piser, MD Mindy Plotkin, DO Louis Pollack, MD Sarah Postma, MD Gregg Pottorff, MD Burton Presberg, MD Charles Preston, MD

John Pyun, MD Paige Radell, MD Jeana Radosevich, MD Robert Raphael, MD Hamid Rassai, MD Katherine Rausa, MD Fiona Redwood, MD Margaret Renik, MD Brian Reyes, MD Kimberly Reynosa, MD William Rhoads, MD Philip Rich, MD Joshua Richards, MD Denise Ricker, MD Jenny Riley, MD Rahul Rishi, MD Daniel Robbins, MD Ronald Robinson, MD Geoffrey Rodriguez, MD Soraya Rofagha, MD Chad Roghair, MD Denise Romero, MD Joseph Rose, MD Lynne Rosen, MD Shawn Rosen, MD Howard Rosenfeld, MD Michael Rosenfield, DO Andrew Ross, MD Kevin Roth, MD Robert Rovner, MD Aimee Rowe, MD Frederick Rowe, MD Richard Rowe, MD Jon Rowland, MD Anabel Ruiz, MD Daniel Rust, MD Iraj Sabahi, MD Gopal Sachdeva, MD John Francis Safanda, MD Elizabeth Salsburg, MD Peter Sam, MD Amarjit Sandhu, MD Nancy Sandoval, MD Vincent Sansone, MD Sebastian Sasu, MD Ronald Sato, MD Gail Savarese, MD Gregory Schaner, MD Timothy Schmidt, MD Janine Senior, MD Armen Serebrakian, MD Todd Severin, MD Payal Shah, MD Rakhee Shah, MD Saurin Shah, MD Selina Shah, MD Shaily Shah, MD Swapnil Shah, MD Amita Sharma, MD Padmaja Sharma, MD Rishi Sharma, MD Salim Shelby, MD Madhu Shetti, MD Angelina Shigeura, MD Yshay Shlesinger, MD Lori Shore, MD

Erin Simms, MD Deborah Simon-Weisberg, MD Sylvia Singer, MD Haramandeep Singh, MD Navdeep Singh, MD Jorge Siopack, MD Daniel Sisti, MD Andrew Smith, MD Grace Sohn, MD Charles Som, DO Helen Song, DO Rebecca Spies, MD Donald Stanford, MD Tara Starr, MD Maria Steelman, MD Andrew Stein, MD Claudell Stephens, Jr., MD Duane Stephens, MD Jeffrey Stern, MD Neil Stollman, MD Michaela Straznicka, MD Charles Strotz, MD Fannie Su, MD Wendy Su, MD Nicole Suleiman, MD Shannon Sullivan-Cramer, MD Peter Sun, MD Michael Sung, MD Vikram Suri, MD Kala Swamynathan, MD Walter Sweeney, II, MD Susan Sykes, MD Natsuko Takakuwa, MD Lloyd Takao, MD Alisa Takeda, DO Vikram Talwar, MD Matthew Tamplen, MD Lorena Tan, MD George Tanaka, MD Michele Tang, MD Jaime Tannenbaum, MD Willam Tanner, MD Gerald Tarder, MD Alexander Tauras, MD Jennifer Taylor, MD Scott Taylor, MD Shine-Nee Teng, MD Allyson Tevrizian, MD Rene Thomas, MD Arthur Ting, MD William Ting, MD Kevin Tomfohrde, DO An Tran, MD Thuy-An Tran, MD Jeffrey Traynor, MD Yogesh Trehan, MD Clark Tsai, MD Wilson Tsai, MD Jessica Tsuei, MD Cynthia Tsui, MD Nanci Tucker, MD Anna Usowicz, MD Usha Vallamdas, MD Poornima Vanguri, MD Juan Vargas, MD Madhavi Vemulapalli, MD

(continued from page 24)

Liana Vesga, MD Elliott Vichinsky, MD Silvia Villagomez, MD Deepa Vincent, MD Bhupinder Virk, MD Maryna Vityuk, MD Christina Vo, MD Cuong Tat Vu, MD Van Thuc Vu, MD Sanya Wadhwa, MD Alexander Wai, MD Kristin Walker, MD Mark Walters, MD Michael Wang, MD Xingyue Wang, MD Henry Watson, MD Louis Weckstein, MD Timothy Wei, MD Lawrence Weil, MD Stephen Wells, MD Christopher Welty, MD Kathryn Welty, MD C. Charles Wen, MD,MBA Jeffrey Wherry, MD Tracy White, MD Danielle Williams, MD Sean Williams, MD Sharon Williams, MD Steven Williams, MD Htay Win, MD Robin Winokur, MD Phillip Wolfe, MD Rosa Won, MD Bryan Wong, MD Sammuel Wong, DO Peter Wong, MD Meghan Woods, MD Samuel Woods, MD Sara Anna Woolf, MD Sarah Woon, MD William Workman, MD Danny Wu, MD David Wu, MD Monte Wu, MD Serena Wu, MD Robert Yan, MD Yan Yan, MD Xiao Yang, MD Xin Yang, MD Lisa Yee, MD Nicole Yee, MD Philip Yee, MD Kris Yogam, MD Anne Yu, MD Rebecca Yu, MD Denise Yun, MD Jamal Zaka, MD Rafik Zarifa, MD Mark Zeme, MD Arzhang Zereshki, MD Li Zhu, MD Jay Zimmerman, MD John Zink, MD Ariel Zodhiates, MD Kenneth Zuckerman, MD Brad Zwahlen, MD

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022

25

CLASSIFIEDS

Medical Equipment for Sale. Retired gastroenterologist is selling gently used colonoscope and gastroscope. Contact Dr. Chadha at (510) 683-9127.

Pleasanton Surgery Center for Lease. Medicare-certified.

Two operating rooms, four-bed recovery center, pre-op area, and conference room. On main road conveniently located minutes from ValleyCare Medical Center and downtown Pleasanton. Off-street parking. Call Doctor Chen at (925) 461-2840.

Primary Care Physician Wanted. Premise Health, the nation’s leader in employer-based healthcare, has an opening for a physician to provide primary care 30 hours per week in our outpatient clinic in Oakland; this is a benefited position. Premise Health is the world’s leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest

employers in the US. Premise partners with its clients to offer fully connected care—in-person and in the digital environment. Operating more than 800 wellness centers in 45 states and Guam, Premise delivers care through onsite, nearsite, mobile, and event solutions. Join Premise Health today!

What makes this opportunity unique: • Practice evidence-based medicine where you are not paid for production • Great compensation and benefit plan • Bottom line is measured by the quality of patient care • A work-life balance that is not just promised • A collaborative approach with a focus on each individual patient • Practice in a supportive, collaborative environment • Less paperwork and administration time For more information, please contact Jeff Ligon, Physician Recruiter, at (615) 468-6233 or jeff.ligon@premisehealth.com.

PUBLIC SERVICE LOAN FORGIVENESS (continued from page 12)

Such PSLF loan forgiveness would help many physicians who train in California and Texas to be able to remain and serve our substantial communities of vulnerable, minority and marginalized patients. It would also help low-income minority students afford medical school and return to their underserved communities to practice and serve in non-profit hospitals and clinics.

PSLF equity in California and Texas would ensure racial equity in education and health care equity in underserved areas.

With medical student loan debt averaging $200,000 in addition to undergraduate debt, the PSLF program is essential to encourage more students to become physicians and address the physician workforce shortages that are harming patient access to timely care. California and Texas are projected to have the largest physician shortages over the next decade due to a significant increase in our populations, an increase in elderly and sicker patients, and an aging physician workforce nearing retirement.

Exclusion from PSLF will exacerbate our physician shortages and patient access to care challenges as physicians will choose to practice in other states where they can access the PSLF program.

We urge the Department to adopt the alternative proposal for California and Texas that maintains the integrity of our state laws, while being consistent with the PSLF statute and program standards.

Thank you for your consideration.

Robert Edelman, MD ACCMA President

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

26

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

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